Stage 4 Lung Cancer

Current Lung Cancer Stats

Lung cancer is the leading cause of cancer death, for both men and women and the statistics for women have been increasing steadily since 1987, to surpass breast cancer as the leading cancer death. (Brown, 1999, p. 7) According the American Cancer Society, more people die of lung cancer than of, breast, prostate or colon cancer combined.

In 2008 there will be about 215,020 new cases of lung cancer (both small cell and non-small cell) in the United States: 114,690 among men and 100,330 among women. About 161,840 people will die of this disease in 2008: 90,810 men and 71,030 women. (American Cancer Society, "How Many People Will Get Non-Small Cell Lung Cancer?" NP)

The incidence is therefore considered relatively high and the rate of diagnosis increases with age and with other factors associated with lifestyle and environment.

Risk Factors

Risk factors for lung cancer include many environmental factors that increase risk but are not necessarily known to be independent causes of cancer. Smoking and second hand smoke are of course the highest risk factors for lung cancer but other environmental exposures also increase risk, including but not limited to occupational exposure to inhaled carcinogens, though lung cancer does frequently occur among people which no known history of environmental exposure to carcinogens and some occupational exposures such as asbestos and/or coal dust are associated with specific types of cancer diagnosed in other categorical manners and treated differently.

Lung cancer is rare in people under the age of 45...The average lifetime chance that a man will develop lung cancer is about 1 in 13. For a woman it is 1 in 16. These numbers include both smokers and non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower. (American Cancer Society, "How Many People Will Get Non-Small Cell Lung Cancer?" NP)

Lung cancer is a serious health threat in all nations, but is of coarse more common in industrial nations and in centers of industrial and/or agricultural works.

Definitions/Background

Carcinoid Tumors

Tumors of the lungs that form masses but are usually contained well and can be cured by surgical intervention.

Lung Cancer:

Any abnormally growing cells that occur primarily and/or first with in the tissues of the lung and/or lining of the lungs.

Non-Small Cell Lung Cancer

The most common form of lung cancer (75%) where cells form into larger tumors or masses during growth stages. Tumors of the lungs can frequently be treated with surgery and a combination of drug and radiation therapy.

Small Cell Lung Cancer

Where cancer cells do not form tumors or masses but simply stratify across areas of the lung. This type of cancer is generally harder to detect and harder to treat as it has usually spread beyond the lungs and cannot be cured by surgery, as a result of its non-containment.

Stages of Lung Cancer:

There are two stages for small cell lung cancer. In the limited stage, the tumor is usually confined to one lung and lymph nodes on the same side of the chest. In the extensive stage, the cancer has spread to the other lung and to lymph nodes on the other side of the chest, or to distant organs.

The stages of non-small cell lung cancer are:

Occult Stage:

Cancer can be detected in patient's saliva, but tumors cannot be found in the lungs.

Stage 0:

Cancer is localized in a few layers of cells and has not grown through the lung's top lining.

Stage I:

The tumor is only in the lung and surrounded by normal tissue.

Stage II:

Cancer has spread to nearby lymph nodes.

Stage III:

Cancer has spread to the chest wall or diaphragm near the lung, or to the lymph nodes in the mediastinum (the area that separates the two lungs), or to the lymph nodes on the other side of the chest or in the neck. This stage is divided into IIIA, which can usually be operated on, and stage IIIB, which usually cannot withstand surgery.

Stage IV:

The cancer has spread to other parts of the body.

Recurrent:

Cancer has returned after treatment. (Brown, 1999, p. 7)

Pathophysiology

Normal Anatomy and Physiology of Lungs

In a very basic sense the lungs are two spongy organs in the center of the chest, the right with three lobes the left with two, that create the chemical exchange between blood and the air we breath. The lungs replace carbon dioxide with some of the oxygen we breath and allow the body to expel the carbon dioxide back out of the body. The air passes from the mouth to the trachea into the bronchus and then into the bronchioles which are clusters of small sacks called alveoli, where actual air and gas exchange occurs.

American Cancer Society, Non-Small Cell Lung Cancer, NP)

Clinical Presentation

Lung cancer presents with symptoms such as persistent cough chest pain weight loss and/or decreased appetite bloody phlegm shortness of breath hoarseness fever for an unknown reason recurring infections, such as bronchitis and pneumonia. (Brown, 1999, p. 7)

Diagnosis of lung cancer is done through several means, including blood tests but is most often detected by chest x-rays and other imaging tools. Yet, it is also clear that lung cancer can take many years to create symptoms and progress so slowly that symptoms, that do clue the patient into a concern are ignored until very far into the disease process and can be attributed to many other disease states and/or causes.

Disease Progression

Most lung cancers begin in the lining of the bronchi, but cancer does begin to occur in other areas of the lung. There are at least two major types of lung cancer, small and non-small cancer cell types, which are treated in different manners. Lung cancer generally takes many years to develop into a situation that is symptomatic or even asymptomatic but able to be detected in x-rays and other forms of diagnostic imaging.

First, there may be areas of pre-cancerous changes in the lung. These changes are not a mass or tumor. They can't be seen on an x-ray and they don't cause symptoms. Over time, these pre-cancerous areas may go on to become true cancer and make chemicals that cause new blood vessels to form nearby. These new blood vessels nourish the cancer cells and allow a tumor to form. Finally, the tumor becomes large enough to show up on an x-ray. At some point, cancer cells can break away and spread to other parts of the body in a process called metastasis. Lung cancer is a life-threatening disease because it often spreads in this way before it is found. (American Cancer Society, Non-Small Cell Lung Cancer, NP)

Lung cancer often spreads through the lymphatic system and stage IV cancer has reached this stage, and gone on to spread to other cells in the body. Lung cancer is often not detected until it has reached this state, known as metastasized cancer. (American Cancer Society, Non-Small Cell Lung Cancer, NP)

Lung cancer frequently goes undetected and only about 15% of lung cancer diagnoses are made before metastasis occurs. The one year survival rate has improved slowly over the years to reach about 40% from 32% in the early 1970s and five-year survival rates have improved from 8% in the 1960s to 14% today. "Improvement in survival rates can be attributed, at least partially, to diagnostics and new drugs that the Food and Drug Administration has approved." (Brown, 1999, p. 7)

Stage IV: The cancer has spread to other parts of the body.

Current Trends

Diagnosis

Diagnosis of lung cancer is usually a multifaceted process. Chest x-rays can be taken or CT scans can be used to identify areas of suspicion. Once these tests have been performed a microscopic analysis of phlegm cells can be performed, if real concern still exists or even if nothing of concern shows on imaging. A bronchoscopy may be performed, where a lighted endoscope tube is passed through the bronchus and bronchioles to identify tumors and even to perform limited sample taking for biopsy. Needle biopsy's frequently follow abnormal tests, of the above nature.

There also are two other diagnostic tools that may be used in place of a biopsy. The Xillix LIFE-Lung Fluorescence Endoscopy System is a medical device FDA approved in 1996 for detecting bronchial tissue abnormalities in patients with previous, current or suspected lung cancer. A tube inserted through a patient's mouth into the bronchi (tubes leading from the trachea to the lungs) delivers a blue laser light to the bronchial tissue. The image the laser reveals is projected onto a video monitor. While normal tissue appears green, abnormal tissue will appear reddish brown. Suspicious areas can then be biopsied. The system was approved for use in conjunction with conventional white light bronchoscopy. While the illumination provided by the white light helps doctors identify tissue that looks abnormal, the new blue laser system detects more tissue changes than can…